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New Sodium Report "Incomplete," says AHA

by Mark F. on Wednesday, May 15, 2013

DALLAS – May 14, 2013 ― The American Heart Association says a new report from the Institute of Medicine (IOM) -- Sodium Intake in Populations: Assessment of Evidence -- is incomplete in its assessment of sodium’s impact on health because it does not focus its examinations on scientific evidence that links excess consumption and high blood pressure. The report found that though reducing sodium intakes from current levels is important, and that there is a positive relationship between higher levels of sodium intake and risk of heart disease, there is not enough evidence to conclude that sodium reduction below 2,300 mg daily leads to less heart disease, stroke and a reduced risk of death.

“While the American Heart Association commends the IOM for taking on the challenging topic of sodium consumption, we disagree with key conclusions,” said the association’s CEO Nancy Brown.The report is missing a critical component – a comprehensive review of well-established evidence which links too much sodium to high blood pressure and heart disease.”

The American Heart Association has meticulously reviewed scientific research and recommends that all Americans eat no more than 1,500 mg a day of sodium. Current average sodium consumption in the United States for people age 2 and up is more than 3,400 mg a day.

A majority of the sodium Americans eat is in the form of salt that is added to processed foods and restaurant foods which makes it difficult for consumers to choose and control how much sodium they consume. While the food industry has reduced the sodium content of some foods, more significant reductions are needed. As a result, the association supports federal regulations that would limit the amount of sodium in foods – the primary strategy stated in a 2010 IOM report, Strategies to Reduce Sodium Intake in the United States.

Much of the research suggesting that decreasing sodium intake has no effect on or leads to increased heart disease and death has been conducted among sick patients, rather than the general population. “The research that the IOM partially based their conclusions on showed inconsistencies in the relationship between sodium intake and health outcomes. Yet these studies were not designed to assess the impact of various levels of sodium intake on cardiovascular health,” said Elliott Antman, M.D., a spokesperson for the American Heart Association, a cardiologist at the Brigham and Women's Hospital and a professor of medicine at Harvard Medical School in Boston. Several of these studies with inconsistent reports are discussed in AHA’s 2012 Presidential Advisory, Sodium, Blood Pressure, and Cardiovascular Disease:  Further Evidence Supporting the American Heart Association Sodium Reduction Recommendations.

Although the scientific community continues to debate the use of biomarkers in general and surrogate indicators of health outcomes, recent evidence attributes 35 percent of heart attack and stroke events, 49 percent of heart failure episodes, and 24 percent of premature deaths to high blood pressure.

The World Health Organization, in its 2012 sodium intake guidelines for adults and children, determined that blood pressure could be a suitable proxy indicator for risk of heart disease and stroke, as did a prior 2005 IOM report.

A recent review of current research conducted by the American Heart Association concluded that people who don’t currently have high blood pressure will benefit from consuming less than 1,500 mg of sodium daily, because less dietary sodium will significantly reduce the rise in blood pressure that occurs as we age. Ninety percent of all Americans are expected to develop high blood pressure in their lifetime. Independent of its effects on blood pressure, excess sodium intake adversely affects the heart, kidneys and blood vessels.

Reducing sodium intake in the United States can also rein in health costs. One estimate suggests a national effort that reduces population sodium intake by 1,200 mg per day could reduce the health burdens related to heart disease in addition to reducing costs by up to $24 billion per year.

Sodium consumption in the United States remains unacceptably high with an average of 3,329 mg in 2001-02 and an average intake of 3,463 mg in 2009-10, the latest year for which federal dietary intake data are available. Yet the Institute of Medicine’s Dietary Reference Intakes point out that 1,500 mg/D is an adequate intake for health.

The American Heart Association advocates for more robust sodium criteria within school nutrition standards, foods marketed to children and foods purchased by employers and government programs. The association also supports improved food labeling that helps consumers understand how much sodium is in their diet and consumer education in restaurants to help consumers choose lower-sodium options.

Successful sodium reduction requires action and partnership at all levels—individuals, healthcare providers, professional organizations, public health agencies, governments and industry. The association urges a renewed and intensive focus on this critically important public health issue. For more information on the association’s sodium reduction efforts, visit www.heart.org/sodium.

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